Since the partnership offered its first workshop in March 2015, community health workers (CHWs), also known as promotores, have been trained on emerging health issues that impact migrant, seasonal, and agricultural workers.

“Each year, we look at emerging health issues, listen to what the CHWs/promotores are hearing in their communities, and tailor our training with up-to-the-moment information,” said Jalaunda Granville*, former Rural Health Project Coordinator at CalSORH. “The goals of the training vary from year to year.”

Statewide Promotores Trainings on Pesticide Illness and Safety poster. Click for more information and evaluation results.

The project uses a “train-the-trainer model”—trainings are held for the CHWs/promotores who then spread the information to the community, said Corinne Chavez, CalSORH Health Program Manager. “The goal of all of these trainings is to provide education and tools for participants to share in their communities. It’s an outreach and education model that offers relevant and reliable health education and resources to California’s rural population.” Chavez added, “OBBH has utilized this model for over a decade.”

Past trainings have been on pesticide illness and safety, Zika awareness and prevention, and mental health and opioid use disorder (OUD). Trainings take place in four regions of the state, with participants drawn from rural parts of those areas, Granville said. More than 300 CHWs/promotores have been trained so far, Chavez said.

“The CHWs/promotores are carefully selected,” Chavez said. “And OBBH’s strong relationships with community-based organizations and community leaders aid in their selection.” A workgroup, composed of OBBH staff, medical professionals, and community leaders and members, develop culturally appropriate curriculum and implement trainings, she said.

After each workshop, participants are given educational manuals and materials, copies of presentations, resource links, and/or contact information for the local resources involved in the workshops, Chavez said.

The CalSORH/OBBH partnership also utilizes additional partnerships with other state and federal agencies. For its workshop on pesticides, OBBH collaborated with CalSORH, the U.S. Environmental Protection Agency, and the California Department of Pesticide Regulation, Chavez said. OBBH and Vision y Compromiso, a leading promotores organization, facilitated its four Zika Awareness workshops in targeted regions of California in 2017, she said.

The partnership provided training and outreach mental health on the dangers of OUD in 2018. It targeted rural areas of the state based on the number of opioid-related deaths found on the California Opioid Overdose Surveillance Dashboard, Chavez said. “California rural communities have the highest rates of OUD in the State,” she said. “OBBH wanted to provide training in a culturally and linguistically appropriate setting because they believe CHWs are uniquely positioned for early intervention and to assist in increasing access to services.”

This year, the partnership is offering training on increasing awareness of antibiotic overuse and misuse in rural communities, with the goal of training 120 promotores/CHWs by 2020. That topic was chosen, Chavez said, “because of the current public health threat it poses throughout the world—we want to provide these trainings as a tool to expand access to healthy practices and services.” If each CHW who is trained on this topic delivers a short presentation to at least 20 community members, she said, the hope is that it will eventually reach at least 500 people in the state.

CalSORH currently is in a five-year intragovernmental agency agreement with OBBH for their services through CalSORH funds, Granville said, “but they also provide services above and beyond their agreement amount.” Funding for the partnership comes from CalSORH’s Federal Office of Rural Healthy Policy SORH grant.

The partnership has allowed CalSORH to reach communities and populations they might not otherwise have, Chavez concluded.

“Early on we recognized that partnering with OBBH was the best way to deliver information and services,” she said. “Working with OBBH was a natural choice in terms of trying to address our rural migrants and Latino populations that may or may not be exposed to this information. We identified their expertise, and knew that they have access to communities and resources. It was a natural link for us to partner with them.”

In a state known for technical innovation, the California State Office of Rural Health (CalSORH) uses technology to keep rural providers in the state abreast of current issues. The SORH frequently hosts webinars on topics of current interest, in addition to in-person training workshops.

“We offer training on the topic of the day,” said Corinne Chavez, CalSORH Program Coordinator. “We definitely try to have a pulse on the emerging issues – so we see if we need to contract out to make sure that health care providers are getting the information they need.”

Topics covered in the recent past include Bringing the Community Apgar Program to California, Affordable Care Act implementation, Medi-Cal Billing and Reconciliation, and ICD-10. Last year, CalSORH hosted a multi-part webinar over three months on LEAN quality improvement training for rural clinics. LEAN is a methodology used by businesses to identify and eliminate waste and improve flow and efficiency; in hospitals, Chavez explained, it can be used to help streamline wasteful patient flow, or to look at how to treat patients in the ER.

“Our staff and partners meet to decide the training topics for the year,” Chavez said. “We project that there will be one to two emerging issues every year and set aside funds to target those issues. For example, when the Office of the National Coordinator for Health Information Technology released new Meaningful Use changes, we decided to offer a training to announce the changes.” The result was the webinar, Meaningful Use: Stage 2 and 2014 Changes, held last month.

The webinars are advertised via listservs, email and the CalSORH web site, and information on them is distributed to various stakeholders in the state, including the Primary Care Office, Primary Care Association, the California Hospital Association, the California Association Rural Health Clinics and the Department of Health Care Services (DHCS) Indian Health Program.

CalSORH also works closely with the DHCS Indian Health Program to address issues of importance to California Indian tribes and health programs. For example, CalSORH sponsors quarterly Indian Health webinars on issues pertaining to Medi-Cal state plan amendments and waivers impacting Indians. Additionally, CalSORH has held emergency preparedness trainings in collaboration with the DHCS Indian Health Program, and has offered trainings to Public Health Nurses working with the American Indian Infant Health Initiative.

CalSORH also offers in-person training workshops. In recent years, it has offered multi-day training on USDA funding for health IT, with subject experts from organizations including the California USDA regional office and the California Hospital Association. In the beginning of the this year, CalSORH sponsored a full-day “train the trainer” workshop for hospital and clinic administrators and staff, to evaluate their health care systems, which it held with the National Center for Rural Health Works. With funding from the Federal Office of Rural Health Policy, CalSORH was able to offer the training free of cost.

CalSORH does not limit participation in its webinars to state residents, but has opened them up to others in Region D, especially for training on federal issues. It is part of what Chavez calls her office’s “ongoing collaboration.” Chavez is proud of the partnership that CalSORH has with other state agencies and DHCS divisions. “We have a wonderful relationship with our state colleagues,” Chavez said. “We try to piggyback when we can to make sure all rural providers receive relevant/real-time training. CalSORH projects focus on collaboration.”